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This study compared the prognostic value of quantified thoracic artery calcium (TAC) including aortic arch on chest CT and coronary artery calcium (CAC) score on ECG-gated cardiac CT.MethodsA total of 2412 participants who underwent both chest CT and ECG-gated cardiac CT at the same period were included in the Multi-Ethnic Study of Atherosclerosis Exam 5. All participants were monitored for incident atherosclerotic cardiovascular disease (ASCVD) events. TAC is defined as calcification in the ascending aorta, aortic arch and descending aorta on chest CT. The quantification of TAC was measured using the Agatston method. Time-dependent receiver-operating characteristic (ROC) curves were used to compare the prognostic value of TAC and CAC scores.ResultsParticipants were 69±9 years of age and 47% were male. The Spearman correlation between TAC and CAC scores was 0.46 (p

Objectives: Assessment of myocardial strain by feature tracking magnetic resonance imaging (FT-MRI) in human fetuses with and without congenital heart disease (CHD) using cardiac Doppler ultrasound (DUS) gating. Methods: A total of 43 human fetuses (gestational age 28–41 weeks) underwent dynamic cardiac MRI at 3 T. Cine balanced steady-state free-precession imaging was performed using fetal cardiac DUS gating. FT-MRI was analyzed using dedicated post-processing software. Endo- and epicardial contours were manually delineated from fetal cardiac 4-chamber views, followed by automated propagation to calculate global longitudinal strain (GLS) of the left (LV) and right ventricle (RV), LV radial strain, and LV strain rate. Results: Strain assessment was successful in 38/43 fetuses (88%); 23 of them had postnatally confirmed diagnosis of CHD (e.g., coarctation, transposition of great arteries) and 15 were heart healthy. Five fetuses were excluded due to reduced image quality. In fetuses with CHD compared to healthy controls, median LV GLS (− 13.2% vs. − 18.9%; p < 0.007), RV GLS (− 7.9% vs. − 16.2%; p < 0.006), and LV strain rate (1.4 s−1 vs. 1.6 s−1; p < 0.003) were significantly higher (i.e., less negative). LV radial strain was without a statistically significant difference (20.7% vs. 22.6%; p = 0.1). Bivariate discriminant analysis for LV GLS and RV GLS revealed a sensitivity of 67% and specificity of 93% to differentiate between fetuses with CHD and healthy fetuses. Conclusion: Myocardial strain was successfully assessed in the human fetus, performing dynamic fetal cardiac MRI with DUS gating. Our study indicates that strain parameters may allow for differentiation between fetuses with and without CHD. Clinical relevance statement: Myocardial strain analysis by cardiac MRI with Doppler ultrasound gating and feature tracking may provide a new diagnostic approach for evaluation of fetal cardiac function in congenital heart disease. Key Points: • MRI myocardial strain analysis has not been performed in human fetuses so far. • Myocardial strain was assessed in human fetuses using cardiac MRI with Doppler ultrasound gating. • MRI myocardial strain may provide a new diagnostic approach to evaluate fetal cardiac function. [ABSTRACT FROM AUTHOR]

Background and Objectives: Myocardial bridging (MB) is still not yet considered a significant finding in Indonesia both radiographically and clinically. Hence, this article aims to assess the prevalence of MB using multi-detector computed tomography (MDCT) and look at factors contributing to stenosis amongst patients with MB. Materials and Methods: This study is cross-sectional in a single centre, with consecutive sampling, looking at all patients who underwent a multi-detector computed tomography (MDCT) scan from February 2021 until February 2023. GraphPad Prism version 9.0.0 for Windows (GraphPad Software, Boston, MA, USA) was used to analyse the results. Results: There are 1029 patients with an MB, yielding a prevalence of 44.3% (95%CI 42.3–46.4). The left anterior descending vessel is the most commonly implicated, with 99.6%. Among those with stenosis, the middle portion of the bridging vessel is the most common site of stenosis (n = 269), followed by the proximal portion (n = 237). The severity of stenosis is more often moderate, with 30–50% (n = 238). Females (odds ratio [OR] of 1.8, 95%CI 1.4–2.3; p-value < 0.0001), older age (t-value 5.6, p-value < 0.0001), symptomatic patients (OR 1.4, 95% CI 1.1–1.9; p-value = 0.013), and higher mean coronary artery calcium score (t-value 11.3, p-value < 0.0001) are more likely to have stenosis. The degree of stenosis is significantly higher in the proximal stenosis group than in the middle stenosis group (t-value 27, p-value < 0.0001). Conclusions: Our research demonstrates that MB may prevent atheromatosis of the coronary segment distal to the MB and predispose the development of atherosclerosis in the section proximal to the bridge. [ABSTRACT FROM AUTHOR]

Introduction: The present study sought to compare the diagnostic accuracy and radiation dose of ECG-gated, ultra-fast, low-dose, high-pitch, spiral (FLASH) mode versus conventional, ECG-gated, sequential coronary artery calcium (CAC) scoring in patients with suspected coronary artery disease (CAD). Methods: The study included 120 patients who underwent both conventional scanning and FLASH mode scanning and were subdivided into derivation and validation cohorts. In the conventional sequential (step-and-shoot) protocol, prospective ECG-gated, non-contrast acquisition was performed at 70% of R-R interval. The spiral (FLASH) mode utilized a high-pitch and high-speed gantry rotation scanning mode where acquisition of the entire heart was done within a single cardiac cycle with prospective ECG-gating at 70% of R-R interval. Results: Correlation between CAC scores derived from conventional (cCAC) and FLASH mode (fCAC) in derivation cohort was excellent (r=0.99; P

We describe a case of a 30-year-old woman with gradually increasing dyspnoea on exertion where CT angiography revealed a unicuspid unicommissural morphology of the aortic valve. The present report highlights the anatomical and embryological aspects of this rare anatomical variant as well as the associated cardiovascular abnormalities.

Introduction: The present study sought to compare the diagnostic accuracy and radiation dose of ECG-gated, ultra-fast, low-dose, high-pitch, spiral (FLASH) mode versus conventional, ECG-gated, sequential coronary artery calcium (CAC) scoring in patients with suspected coronary artery disease (CAD). Methods: The study included 120 patients who underwent both conventional scanning and FLASH mode scanning and were subdivided into derivation and validation cohorts. In the conventional sequential (step-and-shoot) protocol, prospective ECG-gated, non-contrast acquisition was performed at 70% of R-R interval. The spiral (FLASH) mode utilized a high-pitch and high-speed gantry rotation scanning mode where acquisition of the entire heart was done within a single cardiac cycle with prospective ECG-gating at 70% of R-R interval. Results: Correlation between CAC scores derived from conventional (cCAC) and FLASH mode (fCAC) in derivation cohort was excellent (r=0.99; P P<0.0001).> Conclusion: CAC scoring using FLASH mode is feasible with high accuracy and shows excellent agreement with conventional CAC scores at significantly reduced radiation doses. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the prevalence of intra-myocardial fatty scars (IMFS) most likely indicating previous silent myocardial infarction (SMI), as detected on coronary artery calcium (CAC) computed tomography (CT) scans in diabetic patients without history of coronary heart disease (CHD). Methods: Diabetic patients screened for silent coronary insufficiency in a tertiary-care, university hospital between Jan-2015 and Dec-2016 were categorized according to their CAC score in two groups comprising 242 patients with CACS = 0 and 145 patients with CACS ≥ 300. CAC-CT scans were retrospectively evaluated for subendorcardial and transmural IMFS of the left ventricle. Adipose remodeling, patients' characteristics, cardiovascular risk factors and metabolic profile were compared between groups. Results: Eighty-three (21%) patients with IMFS were identified, 55 (37.9%) in the group CACS ≥ 300 and 28 (11.6%) in the CACS = 0 (OR = 4.67; 95% CI = 2.78–7.84; p < 0.001). Total and average surface of IMFS and their number per patient were similar in both groups (p = 0.55; p = 0.29; p = 0.61, respectively). In the group CACS ≥ 300, patients with IMFS were older (p = 0.03) and had longer-lasting diabetes (p = 0.04). Patients with IMFS were older and had longer history of diabetes, reduced glomerular filtration rate, more coronary calcifications (all p < 0.05), and higher prevalence of carotid plaques (OR = 3.03; 95% CI = 1.43–6.39, p = 0.004). After correction for other variables, only a CACS ≥ 300 (OR = 5.12; 95% CI = 2.66–9.85; p < 0.001) was associated with an increased risk of having IMFS. Conclusions: In diabetic patients without known CHD, IMFSs were found in patients without coronary calcifications, although not as frequently as in patients with heavily calcified coronary arteries. It remains to be established if this marker translates in an upwards cardiovascular risk restratification especially in diabetic patients with CACS = 0. Clinical relevance statement: In diabetic patients without history of coronary heart disease, intramyocardial fatty scars, presumably of post-infarction origin, can be detected on coronary artery calcium CT scans more frequently, but not exclusively, if the coronary arteries are heavily calcified as compared to those without calcifications. Key Points: • Intramyocardial fatty scars (IMFS), presumably of post-infarction origin, can be detected on coronary artery calcium (CAC) CT scans more frequently, but not exclusively, in diabetic patients with CACS ≥ 300 as compared to patients CACS = 0. • Patients with IMFS were older and had longer history of diabetes, reduced glomerular filtration rate, and more coronary calcifications. • Carotid plaques and CACS ≥ 300 were associated with an increased risk of having IMFS, about three and five folds respectively. [ABSTRACT FROM AUTHOR]

BackgroundExtracellular volume fraction (ECV) quantification with cardiovascular magnetic resonance (CMR) T1 mapping is a powerful tool for the characterization of focal or diffuse myocardial fibrosis. However, it is technically challenging to acquire high-quality T1 and ECV maps in small animals for preclinical research because of high heart rates and high respiration rates. In this work, we developed an electrocardiogram (ECG)-less, free-breathing ECV mapping method using motion-resolved CMR Multitasking on a 9.4 T small animal CMR system. The feasibility of characterizing diffuse myocardial fibrosis was tested in a rat heart failure model with preserved ejection fraction (HFpEF).MethodsHigh-salt fed rats diagnosed with HFpEF (n = 9) and control rats (n = 9) were imaged with the proposed ECV Multitasking technique. A 25-min exam, including two 4-min T1 Multitasking scans before and after gadolinium injection, were performed on each rat. It allows a cardiac temporal resolution of 20 ms for a heart rate of ~ 300 bpm. Myocardial ECV was calculated from the hematocrit (HCT) and fitted T1 values of the myocardium and the blood pool. Masson's trichrome stain was used to measure the extent of fibrosis. Welch's t-test was performed between control and HFpEF groups.ResultsECV was significantly higher in the HFpEF group (22.4% ± 2.5% vs. 18.0% ± 2.1%, P = 0.0010). A moderate correlation between the ECV and the extent of fibrosis was found (R = 0.59, P = 0.0098).ConclusionsMotion-resolved ECV Multitasking CMR can quantify ECV in the rat myocardium at high heart rates without ECG triggering or respiratory gating. Elevated ECV found in the HFpEF group is consistent with previous human studies and well correlated with histological data. This technique has the potential to be a viable imaging tool for myocardial tissue characterization in small animal models.

We report a case of a 53-year-old man with a "short RCA" seen coursing within the proximal part of the right atrioventricular (AV) groove and terminating in the mid-portion of the right AV groove and a "long RCA" seen to have a proximal course outside the right AV groove, over the free wall of the right ventricle, where it gave rise to the right ventricular and acute marginal branches before returning to the right AV groove in its distal course. The discussion highlights the need for revisiting the nomenclature of "dual RCA and drawing a distinction between "dual" and "duplicated" RCA.

Aims: To evaluate a deep-learning model (DLM) for detecting coronary stenoses in emergency room patients with acute chest pain (ACP) explored with electrocardiogram-gated aortic computed tomography angiography (CTA) to rule out aortic dissection. Methods and results: This retrospective study included 217 emergency room patients (41% female, mean age 67.2 years) presenting with ACP and evaluated by aortic CTA at our institution. Computed tomography angiography was assessed by two readers, who rated the coronary arteries as 1 (no stenosis), 2 (<50% stenosis), or 3 (≥50% stenosis). Computed tomography angiography was categorized as high quality (HQ), if all three main coronary arteries were analysable and low quality (LQ) otherwise. Curvilinear coronary images were rated by a DLM using the same system. Per-patient and per-vessel analyses were conducted. One hundred and twenty-one patients had HQ and 96 LQ CTA. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of the DLM in patients with high-quality image for detecting ≥50% stenoses were 100, 62, 59, 100, and 75% at the patient level and 98, 79, 57, 99, and 84% at the vessel level, respectively. Sensitivity was lower (79%) for detecting ≥50% stenoses at the vessel level in patients with low-quality image. Diagnostic accuracy was 84% in both groups. All 12 patients with acute coronary syndrome (ACS) and stenoses by invasive coronary angiography (ICA) were rated 3 by the DLM. Conclusion: A DLM demonstrated high NPV for significant coronary artery stenosis in patients with ACP. All patients with ACS and stenoses by ICA were identified by the DLM. Graphical Abstract Study highlights and presentation of the study workflow. Showcase of a proximal RCA occlusion opportunisticall identified by the AI model in a 54 year-old male patient with acute chest pain. ACS, acute coronary syndrome; AI, artificial intelligence; CTA, computed tomography angiography; CX, circumflex artery; ECG, electrocardiogram; ICA, invasive coronary angiography; LAD, left anterior descending artery; MPR, multiplanar reconstruction; RCA, right coronary artery. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a leading cause of morbidity. Strategies for preventing HF are paramount. Prevalent extracoronary calcification is associated with HF risk but less is known about progression of mitral annular (MAC) and aortic valve calcification (AVC) and HF risk. Progression of valvular calcification (VC) [interval change of >0 units/yr] was assessed by 2 cardiac computed tomography scans over a median of 2.4 years. We used Cox regression to determine the risk of adjudicated HF and linear mixed effects models to determine 10-year change in left ventricular (LV) parameters measured by cardiac magnetic resonance imaging associated with VC progression. We studied 5,591 MESA participants free of baseline cardiovascular disease. Mean ± SD age was 62 ± 10 years; 53% women; 83% had no VC progression, 15% progressed at 1 site (AVC or MAC) and 3% at both sites. There were 251 incident HF over 15 years. After adjusting for cardiovascular risk factors, the hazard ratios (95% confidence interval) of HF associated with VC progression at 1 and 2 sites were 1.62 (1.21 to 2.17) and 1.88 (1.14 to 3.09), respectively, compared with no progression (p-for-trend

BackgroundCoronary artery calcium (CAC) is a guideline recommended cardiovascular disease (CVD) risk stratification tool that increases with age and is associated with non-cardiovascular disease outcomes including cancer. We sought to define the age-specific change in the association between CAC and cause-specific mortality.MethodsThe Coronary Artery Calcium Consortium includes 59,502 asymptomatic patients age 40-75 without known CVD. Age-stratified mortality rates and parametric survival regression modeling was performed to estimate the age-specific CAC score at which CVD and cancer mortality risk were equal.ResultsThe mean age was 54±8 years (67% men) and there were 2,423 deaths over a mean 12±3 years follow-up. Among individuals with CAC = 0, cancer was the leading cause of death, with low CVD mortality rates for both younger (40-54 years) 0.2/1,000 person-years and older participants (65-75 years) 1.3/1,000 person-years. When CAC ≥400, CVD was consistently the leading cause of death among younger (71% of deaths) and older participants (56% of deaths). The CAC score at which CVD overtook cancer as the leading cause of death increased exponentially with age and was approximately 115 at age 50 and 380 at age 65.ConclusionsRegardless of age, when CAC = 0 cancer was the leading cause of death and the cardiovascular disease mortality rate was low. Our age-specific estimate for the CAC score at which CVD overtakes cancer mortality allows for a more precise approach to synergistic prediction and prevention strategies for CVD and cancer.

We describe a case of a 30-year-old woman with gradually increasing dyspnoea on exertion where CT angiography revealed a unicuspid unicommissural morphology of the aortic valve. The present report highlights the anatomical and embryological aspects of this rare anatomical variant as well as the associated cardiovascular abnormalities. [ABSTRACT FROM AUTHOR]

We sought to assess the feasibility of computed tomography coronary angiography (CTCA) on a 128-slice, dual source scanner in children with acute and convalescent phase Kawasaki disease (KD).A prospective study of 49 children with KD (12 at presentation and 37 in the convalescent phase) was conducted between November 2013 and April 2015. CTCA was performed with either prospective (n = 37) or retrospective (n = 12) electrocardiographic gating. A radiologist blinded to clinical profile and echocardiogram evaluated each scan.Median age (36 boys and 13 girls) was 7 years. Median dose-length product value and median effective CT radiation dose was 32mGycm (interquartile range [IQR]: 21-74) and 0.54 miliSieverts (mSv) (IQR: 0.77-3.2) for all scans, and 27mGycm (IQR: 18.5-33.75) and 0.48mSv (IQR: 0.18-1.17) for prospectively triggered scans (n = 37). Fourteen subjects (30 coronary segments) showed abnormalities by CTCA including aneurysms (n = 27) and stenoses (n = 3). In the acute phase (n = 12), aneurysms were detected in 5 children (18 segments).CTCA allows comprehensive evaluation of coronary arteries in children with KD.

Both noncontrast and contrast-enhanced approaches to gated thoracic magnetic resonance angiography (MRA) for aortic root evaluation have been reported at 3T. We compare qualitative and quantitative image quality measures for the two approaches, and assess the reproducibility of standard aortic measurements. Respiratory and cardiac gated MRA of the chest was performed at 3T in 45 patients: 23 after administration of iron-based blood pool contrast, and 22 without contrast. Image quality was assessed with a 5-point Likert scale, vessel lumen-to-muscle contrast ratios, and vessel wall sharpness. Two reviewers measured the ascending aorta diameter and valve annulus area. Interrater agreement was assessed using Bland-Altman plots and coefficient of variation (CV). Qualitative image quality was better with blood pool contrast in all principal vessels of the chest (mean Likert of 4.20 ± 0.79 vs. 2.60 ± 0.77, p

We report a case of a 53-year-old man with a "short RCA" seen coursing within the proximal part of the right atrioventricular (AV) groove and terminating in the mid-portion of the right AV groove and a "long RCA" seen to have a proximal course outside the right AV groove, over the free wall of the right ventricle, where it gave rise to the right ventricular and acute marginal branches before returning to the right AV groove in its distal course. The discussion highlights the need for revisiting the nomenclature of "dual RCA and drawing a distinction between "dual" and "duplicated" RCA. [ABSTRACT FROM AUTHOR]

Normative values for intracardiac and extracardiac vascular structures help in understanding normal growth and changes over time in children; this normative data is not currently available for ECG-gated computed tomography angiography (CTA). We sought to establish ECG-gated CTA-derived normative values for the aortic root, aorta, and aortic arch in children. Aortic root, ascending aorta, aortic arch, and descending aorta were measured in systole and diastole in 100 subjects who had ECG-gated CTA at our center between January 2015 and December 2020 and met our inclusion criteria. The allometric exponent (AE) for each parameter was derived, and the parameter/body surface area AE (BSA AE ) was established using the previously described methods. Using this data, normalized mean, cross-sectional area, and standard deviation were calculated. Z-score curves were plotted in relation to the BSA for all measurements., Conclusion: Our study reports systolic and diastolic ECG-gated CTA Z-scores along with normative curves in relation to BSA for the aortic root, aorta, and aortic arch in children., What Is Known: • Normative data for intracardiac and extracardiac vascular structures in the pediatric population are available for echocardiography, cardiac MRI and non-ECG gated CTA. • Z-scores with standard deviations are commonly used in children, but SDs are not constant across body sizes due to heteroscedasticity., What Is New: • Allometric exponent was derived for each parameter and the parameter/body surface area (BSA) was established. • This is the first ECG-gated CTA study to provide normative en face systolic, diastolic diameters and cross-sectional areas along with Z-scores and normative curves for the aortic root, aorta and aortic arch in children., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Cardiac CT for coronary artery calcium (CAC) scoring exposes patients to 1 ​mSv of radiation. A new CT scout method utilizing ultra-low dose CT (3D Landmark) offers tomographic cross-sectional imaging, which provides axial images from which CAC can be estimated. The purpose of our study is to analyze the association between estimated CAC burden on 3D Landmark scout imaging vs dedicated ECG-gated CACS., Methods: Consecutive patients over a 9-month period undergoing non-contrast ECG-gated CACS planned with 3D Landmark scout imaging were included. Extent of CAC on 3D Landmark scout imaging was scored from 0 to 3 (none, mild, moderate, severe). Agatston CACS was converted to an ordinal score from 0 to 3, corresponding to absent (0), mild (1-99), moderate (100-400), or severe (>400). Fischer's exact test, weighted kappa coefficient, and paired t-tests were used for analysis., Results: Of 150 patients, 51.3% were female with mean age 49.0 ​± ​16.8 and BMI 28.6 ​± ​12.3. Sensitivity of 3D Landmark in identifying calcium was 96.2%, with specificity of 100%. There was strong interrater agreement between 3D Landmark calcium scoring and CACS, with weighted kappa coefficient 0.97 ​± ​0.01(CI 0.95-0.99). Radiation dose-length-product was significantly lower for 3D Landmark imaging vs. dedicated ECG-gated CACS (9.7 ​± ​3.6 vs 43.8 ​± ​26.4 ​mGy ​cm, p ​< ​0.001) despite longer scan length (465.0 ​± ​160.8 vs 123.0 ​± ​12.7 ​mm, respectively)., Conclusion: Estimated coronary artery calcium on 3D Landmark scout images correlates strongly with Agatston CACS, demonstrating utility in assessing cardiovascular risk without introducing additional radiation or costs., Competing Interests: Declaration of competing interest John Schuzer is an employee of Canon Medical, but did not participate in data collection or analysis. No other authors declare conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Transcatheter aortic valve replacement (TAVR) is preferred therapy for elderly patients with severe aortic stenosis (AS) and increasingly used in younger patient populations with good safety and efficacy outcomes. However, cardiac conduction abnormalities remain a frequent complication after TAVR ranging from relative benign interventriculair conduction delays to prognostically relevant left bundle branch block and complete atrio-ventricular (AV) block requiring permanent pacemaker implantation (PPI). Although clinical, procedural and electrocardiographic factors have been identified as predictors of this complication, there is a need for advanced strategies to control the burden of conduction defects particularly as TAVR shifts towards younger populations. This state of the art review highlights the value of ECG-synchronized computed tomographic angiography (CTA) evaluation of the aortic root to better understand and manage conduction problems post-TAVR. An update on CTA derived anatomic features related to conduction issues is provided and complemented with computational framework modelling. This CTA-derived 3-dimensional anatomical reconstruction tool generates patient-specific TAVR simulations enabling operators to adapt procedural strategy and implantation technique to mitigate conduction abnormality risks., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Arterial calcification reflects an atherosclerotic process associated with vascular stiffness. Whether baseline coronary artery calcium (CAC) and extra-coronary calcium (ECC), measured using noncontrast computed tomography imaging, are associated with incident hypertension is poorly understood. We studied participants from the Multi-Ethnic Study of Atherosclerosis without measured or self-reported hypertension at baseline. Incident hypertension was defined by blood pressure criteria (BP, ≥140/90 mmHg), BP medication use, or both, and was assessed at in-person visits. We analyzed incident hypertension using multivariable-adjusted discrete-time proportional hazards models. Net reclassification improvement (NRI) assessed whether CAC reclassified hypertension risk when added to the Framingham hypertension risk score. Among 3,304 subjects analyzed, mean age was 59 ± 10 years; 48% were male and 42% were white. There were 1,283 incident hypertension cases over a median (interquartile range) follow-up time of 10.6 (4.5, 11.5) years. Each 1-unit increase in ln(CAC+1) was independently associated with a 12% higher risk of hypertension (95% confidence interval [CI] 9% to 16%). Relative to CAC = 0, patients with CAC >400 had a hazard ratio for incident hypertension of 2.2 (95% CI 1.8 to 2.9). There was no interaction by age, gender, or baseline BP (p = 0.43, 0.19, 0.09, respectively). Continuous NRI analyses demonstrated that CAC can reclassify risk of incident hypertension; NRI = 0.19 (95% CI 0.10 to 0.26). Furthermore, all measurements of ECC were significantly associated with incident hypertension, even after adjustment for CAC (hazard ratios ranging from 1.36 to 1.38). In conclusion, patients with CAC and ECC are at markedly higher risk of incident hypertension and may benefit from more intensified prevention efforts.

ObjectiveThis work presents a highly-accelerated, self-gated, free-breathing 3D cardiac cine MRI method for cardiac function assessment.Materials and methodsA golden-ratio profile based variable-density, pseudo-random, Cartesian undersampling scheme was implemented for continuous 3D data acquisition. Respiratory self-gating was achieved by deriving motion signal from the acquired MRI data. A multi-coil compressed sensing technique was employed to reconstruct 4D images (3D+time). 3D cardiac cine imaging with self-gating was compared to bellows gating and the clinical standard breath-held 2D cine imaging for evaluation of self-gating accuracy, image quality, and cardiac function in eight volunteers. Reproducibility of 3D imaging was assessed.ResultsSelf-gated 3D imaging provided an image quality score of 3.4 ± 0.7 vs 4.0 ± 0 with the 2D method (p = 0.06). It determined left ventricular end-systolic volume as 42.4 ± 11.5 mL, end-diastolic volume as 111.1 ± 24.7 mL, and ejection fraction as 62.0 ± 3.1%, which were comparable to the 2D method, with bias ± 1.96 × SD of -0.8 ± 7.5 mL (p = 0.90), 2.6 ± 3.3 mL (p = 0.84) and 1.4 ± 6.4% (p = 0.45), respectively.ConclusionThe proposed 3D cardiac cine imaging method enables reliable respiratory self-gating performance with good reproducibility, and provides comparable image quality and functional measurements to 2D imaging, suggesting that self-gated, free-breathing 3D cardiac cine MRI framework is promising for improved patient comfort and cardiac MRI scan efficiency.

ObjectivesThe aim of this work is the development of coronary atherosclerosis T1-weighted characterization with integrated anatomical reference (CATCH) technique and the validation by comparison with high-risk plaque features (HRPF) observed on intracoronary optical coherence tomography (OCT) and invasive coronary angiography.BackgroundT1-weighted cardiac magnetic resonance with or without contrast media has been used for characterizing coronary atherosclerosis showing promising prognostic value. Several limitations include: 1) coverage is limited to proximal coronary segments; 2) spatial resolution is low and often anisotropic; and 3) a separate magnetic resonance angiography acquisition is needed to localize lesions.MethodsCATCH acquired dark-blood T1-weighted images and bright-blood anatomical reference images in an interleaved fashion. Retrospective motion correction with 100% respiratory gating efficiency was achieved. Reference control subjects (n = 13) completed both pre- and post-contrast scans. Stable angina patients (n = 30) completed pre-contrast scans, among whom 26 eligible patients also completed post-contrast scans. After cardiac magnetic resonance, eligible patients (n = 22) underwent invasive coronary angiography and OCT for the interrogation of coronary atherosclerosis. OCT images were assessed and scored for HRPF (lipid-richness, macrophages, cholesterol crystals, and microvessels) by 2 experienced analysts blinded to magnetic resonance results.ResultsPer-subject analysis showed none of the 13 reference control subjects had coronary hyperintensive plaques (CHIP) in either pre-contrast or post-contrast CATCH. Five patients had CHIP on pre-contrast CATCH and 5 patients had CHIP on post-contrast CATCH. Patients with CHIP had greater lipid abnormality than those without. Per-segment analysis showed elevated pre- and post-contrast plaque to myocardium signal ratio in the lesions with HRPF versus those without. Positive correlation was observed between plaque to myocardium signal ratio and OCT HRPF scoring. CHIP on pre-contrast CATCH were associated with significantly higher stenosis level than non-CHIP on invasive coronary angiography.ConclusionsCATCH provided accelerated whole heart coronary plaque characterization with simultaneously acquired anatomical reference. CHIP detected by CATCH showed positive association with high-risk plaque features on invasive imaging studies.

We report a case of an 87-year-old man where coronary CT angiography incidentally demonstrated a "split" right coronary artery (RCA) featuring a "split" posterior descending artery. This case focusses on the morphological description of this variant as well as its differentiation from a "dual" or "duplicated" RCA.

Purpose: To compare two blind source separation (BSS) techniques to principal component analysis and the electrocardiogram for the identification of cardiac triggers in self-gated free-running 5D whole-heart MRI. To ascertain the precision and robustness of the techniques, they were compared in three different noise and contrast regimes., Methods: The repeated superior-inferior (SI) projections of a 3D radial trajectory were used to extract the physiological signals in three cardiac MRI cohorts: (1) 9 healthy volunteers without contrast agent injection at 1.5T, (2) 30 ferumoxytol-injected congenital heart disease patients at 1.5T, and (3) 12 gadobutrol-injected patients with suspected coronary artery disease at 3T. Self-gated cardiac triggers were extracted with the three algorithms (principal component analysis [PCA], second-order blind identification [SOBI], and independent component analysis [ICA]) and the difference with the electrocardiogram triggers was calculated. PCA and SOBI triggers were retained for image reconstruction. The image sharpness was ascertained on whole-heart 5D images obtained with PCA and SOBI and compared among the three cohorts., Results: SOBI resulted in smaller trigger differences in Cohorts 1 and 3 compared to PCA (p < 0.01) and in all cohorts compared to ICA (p < 0.04). In Cohorts 1 and 3, the sharpness increased significantly in the reconstructed images when using SOBI instead of PCA (p < 0.03), but not in Cohort 2 (p = 0.4)., Conclusion: We have shown that SOBI results in more precisely extracted self-gated triggers than PCA and ICA. The validation across three diverse cohorts demonstrates the robustness of the method against acquisition variability., (© 2024 The Author(s). Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Purpose: We aim to quantify multiaxial cardiac pulsatility-induced deformation of the thoracic aorta after ascending thoracic endovascular aortic repair (TEVAR) as a part of the GORE ARISE Early Feasibility Study., Materials and Methods: Fifteen patients (7 females and 8 males, age 73±9 years) with ascending TEVAR underwent computed tomography angiography with retrospective cardiac gating. Geometric modeling of the thoracic aorta was performed; geometric features including axial length, effective diameter, and centerline, inner surface, and outer surface curvatures were quantified for systole and diastole; and pulsatile deformations were calculated for the ascending aorta, arch, and descending aorta., Results: From diastole to systole, the ascending endograft exhibited straightening of the centerline (0.224±0.039 to 0.217±0.039 cm -1 , p<0.05) and outer surface (0.181±0.028 to 0.177±0.029 cm -1 , p<0.05) curvatures. No significant changes were observed for inner surface curvature, diameter, or axial length in the ascending endograft. The aortic arch did not exhibit any significant deformation in axial length, diameter, or curvature. The descending aorta exhibited small but significant expansion of effective diameter from 2.59±0.46 to 2.63±0.44 cm (p<0.05)., Conclusion: Compared with the native ascending aorta (from prior literature), ascending TEVAR damps axial and bending pulsatile deformations of the ascending aorta similar to how descending TEVAR damps descending aortic deformations, while diametric deformations are damped to a greater extent. Downstream diametric and bending pulsatility of the native descending aorta was muted compared with that in patients without ascending TEVAR (from prior literature). Deformation data from this study can be used to evaluate the mechanical durability of ascending aortic devices and inform physicians about the downstream effects of ascending TEVAR to help predict remodeling and guide future interventional strategies., Clinical Impact: This study quantified local deformations of both stented ascending and native descending aortas to reveal the biomechanical impact of ascending TEVAR on the entire thoracic aorta, and reported that the ascending TEVAR muted cardiac-induced deformation of the stented ascending aorta and native descending aorta. Understanding of in vivo deformations of the stented ascending aorta, aortic arch and descending aorta can inform physicians about the downstream effects of ascending TEVAR. Notable reduction of compliance may lead to cardiac remodeling and long-term systemic complications. This is the first report which included dedicated deformation data regarding ascending aortic endograft from clinical trial., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: G.-Y.K.S. has received research funding and/or consulting fees from Bentley InnoMed, Medtronic, Optimed Medical Instruments, Terumo Aortic, and W. L. Gore & Associates. M.C.N. has received salary from W. L. Gore & Associates. E.E.R. has received research funding and/or consulting fees from Cook, Artivion, Edwards Lifesciences, W.L. Gore & Associates, Medtronic, and Terumo Aortic. C.P.C. has received research funding and/or consulting fees from Abbott Laboratories, AneuMed, Arsenal Medical, Bentley InnoMed, Confluent Medical Technologies, Endospan, Medtronic, Optimed Medical Instruments, Qmedics, ReValve Solutions, Starlight Cardiovascular, Terumo Aortic, and W. L. Gore & Associates. J.B. and Y.D.Z. have nothing to disclose.

ABSTRACT Many health systems have been using coronary CT angiography (CCTA) as a first-line examination for ischaemic heart disease patients in various countries. The rising number of CCTA examinations has led to a significant increase in the number of reported incidental extracardiac findings, mainly in the chest. Pulmonary nodules are the most common incidental findings on CCTA scans, as there is a substantial overlap of risk factors between the population seeking to exclude ischaemic heart disease and those at risk of developing lung cancer (i.e., advanced age and smoking habits). However, most incidental findings are clinically insignificant and actively pursuing them could be cost-prohibitive and submit the patient to unnecessary and potentially harmful examinations. Furthermore, there is little consensus regarding when to report or actively exclude these findings and how to manage them, that is, when to trigger an alert or to immediately refer the patient to a pulmonologist, a thoracic surgeon or a multidisciplinary team. This pictorial essay discusses the current literature on this topic and is illustrated with a review of CCTA scans. We also propose a checklist organised by organ and system, recommending actions to raise awareness of pulmonologists, thoracic surgeons, cardiologists and radiologists regarding the most significant and actionable incidental findings on CCTA scans.

The purpose of this work was to validate a parallel imaging (PI) and compressed sensing (CS) combined reconstruction method for a recently proposed 4D non-breath-held, multiphase, steady-state imaging technique (MUSIC) cardiovascular MRI in a cohort of pediatric congenital heart disease patients. We implemented a graphics processing unit accelerated CS-PI combined reconstruction method and applied it in 13 pediatric patients who underwent cardiovascular MRI after ferumoxytol administration. Conventional breath-held contrast-enhanced magnetic resonance angiography (CE-MRA) was first performed during the first pass of ferumoxytol injection, followed by the original MUSIC and the proposed CS-PI MUSIC during the steady-state distribution phase of ferumoxytol. Qualities of acquired images were then evaluated using a four-point scale. Left ventricular volumes and ejection fractions calculated from the original MUSIC and the CS-PI MUSIC were also compared with conventional multi-slice 2D cardiac cine MRI. The proposed CS-PI MUSIC reduced the imaging time of the MUSIC acquisition to 4.6 ± 0.4 min from 8.9 ± 1.2 min. Computationally intensive image reconstruction was completed within 5 min without interruption of sequential clinical scans. The proposed method (mean 3.3-4.0) provided image quality comparable to that of the original MUSIC (3.2-4.0) (all P ≥ 0.42), and better than conventional breath-held first-pass CE-MRA (1.1-3.3) for 13 anatomical structures (all P ≤ 0.0014) with good inter-observer agreement (κ > 0.46). The calculated ventricular volumes and ejection fractions from both original MUSIC (r > 0.90) and CS-PI MUSIC (r > 0.85) correlated well with 2D cine imaging. In conclusion, PI and CS were successfully incorporated into the 4D MUSIC acquisition to further reduce scan time by approximately 50% while maintaining highly comparable image quality in a clinically practical reconstruction time.

RationaleIndividuals with HIV are at increased risk for coronary artery disease (CAD). Early detection of subclinical CAD by assessment of coronary artery calcium (CAC) may help risk stratify and prevent CAD events in these individuals. However, the current standard to quantify CAC i.e. Agatston scoring requires EKG-gated cardiac CT imaging.ObjectiveTo determine if the assessment of CAC using non-EKG-gated chest CT and the Weston scoring system is a useful surrogate for Agatston scores in HIV-infected and HIV-uninfected individuals.Methods and measurementsCAC was assessed by both the Weston and Agatston score in 108 men enrolled in the Multicenter AIDS Cohort Study.ResultsParticipants were 55.2 (IQR 50.4; 59.9) years old and 62 (57.4%) were seropositive for HIV. Inter-observer agreement (rs = 0.94, κ = 90.0%, p

PurposeTo improve the coronary visualization quality of four-dimensional (4D) coronary MR angiography (MRA) through cardiac motion correction and iterative reconstruction.MethodsA contrast-enhanced, spoiled gradient echo sequence with 3D radial trajectory and self-gating was used for 4D coronary MRA data acquisition at 3 Tesla. A whole-heart 16-phase cine series was reconstructed with respiratory motion correction. Nonrigid registration was performed between the identified quiescent phases and a reference. The motion information of all included phases was then used along with the corresponding k-space data to iteratively reconstruct the final image. Healthy volunteer studies (N = 13) were conducted to compare the proposed method with the conventional strategy, which accepts data from a single, contiguous window out of the original 16-phase data. Apparent signal-to-noise ratio (aSNR) and coronary sharpness were used as the image quality metrics.ResultsThe proposed method significantly improved aSNR (11.89 ± 3.76 to 13.97 ± 5.21; P = 0.005) and scan efficiency (18.8% ± 6.0% to 40.9% ± 9.7%; P

PurposeTo optimize a diffusion-prepared balanced steady-state free precession cardiac MRI (CMR) technique to perform diffusion-tensor CMR (DT-CMR) in humans on a 3 Tesla clinical scanner METHODS: A previously developed second order motion compensated (M2) diffusion-preparation scheme was significantly shortened (40%) yielding sufficient signal-to-noise ratio for DT-CMR imaging. In 20 healthy volunteers and 3 heart failure (HF) patients, DT-CMR was performed comparing no motion compensation (M0), first order motion compensation (M1), and the optimized M2. Mean diffusivity (MD), fractional anisotropy (FA), helix angle (HA), and HA transmural slope (HATS) were calculated. Reproducibility and success rate (SR) were investigated.ResultsM2-derived left ventricular (LV) MD, FA, and HATS (1.4 ± 0.2 μm2 /ms, 0.28 ± 0.06, -1.0 ± 0.2 °/%trans) were significantly (P  0.85) and SR (82%) than M1 (ICC = 0.20-0.85; SR = 37%) and M0 (ICC = 0.20-0.30; SR = 11%). M2 DT-CMR was able to yield HA maps with smooth transmural transition from endocardium to epicardium.ConclusionThe proposed M2 DT-CMR reproducibly yielded bulk motion robust estimations of mean LV MD, FA, HA, and HATS on a 3T clinical scanner. Magn Reson Med 76:1354-1363, 2016. © 2016 International Society for Magnetic Resonance in Medicine.

ObjectivesThe aim of this study was to determine the correlation between coronary artery calcium (CAC) scores on 3 mm electrocardiography (ECG)-gated computed tomography (CT) scans and standard 6 mm chest CT scans, and to compare relative strength of associations of CAC on each scan type with mortality risk.BackgroundCoronary artery calcification predicts cardiovascular disease (CVD) and all-cause mortality, and is typically measured on ECG-gated 3 mm CT scans. Patients undergo standard 6 mm chest CTs for various clinical indications much more frequently, but CAC is not usually quantified. To better understand the usefulness of standard chest CTs to quantify CAC, we conducted a case-control study among persons who had both scan types.MethodsBetween 2000 and 2003, 4,544 community-living individuals self- or physician-referred for "whole-body" CT scans, had 3 mm ECG-gated CTs and standard 6 mm chest CTs, and were followed for mortality through 2009. In this nested case-control study, we identified 157 deaths and 494 controls frequency matched (1:3) on age and sex. The Agatston method quantified CAC on both scan types. Unconditional logistic regression determined associations with mortality, accounting for CVD risk factors.ResultsParticipants were 68 ± 11 years of age and 63% male. The Spearman correlation of CAC scores between the 2 scan types was 0.93 (p < 0.001); median CAC scores were lower on 6 mm CTs compared to 3 mm CTs (22 vs.104 Agatston units, p < 0.001). Adjusted for traditional CVD risk factors, each standard deviation higher CAC score on 6 mm CTs was associated with 50% higher odds of death (odds ratio: 1.5; 95% confidence interval: 1.2 to 1.9), similar to 50% higher odds on the 3 mm ECG-gated CTs (odds ratio: 1.5; 95% confidence interval: 1.1 to 1.9).ConclusionsCAC scores on standard 6 mm chest CTs are strongly correlated with 3 mm ECG-gated CTs and similarly predict mortality in community-living individuals. Chest CTs performed for other clinical indications may provide an untapped resource to garner CVD risk information without additional radiation exposure or expense.

Purpose: In planning transcatheter aortic valve replacement (TAVR), retrospective cardiac spiral-CT is recommended to measure aortic annulus with subsequent CT-angiography (CTA) to evaluate access routes. Photon-counting detector (PCD)-CT enables to assess the aortic annulus in desired cardiac phases, using prospective ECG-gated high-pitch CTA. The aim of this study was to evaluate the measurement accuracy of aortic annulus using prospective ECG-gated high-pitch CTA against retrospective spiral-CT reference., Method: Thirty patients underwent cardiac spiral-CT and prospective ECG-gated (30% R-R on aortic valve level) high-pitch CTA. Using propensity score matching, another 30 patients were identified whose CTA was performed using high-pitch mode without ECG-synchronization. Two investigators measured annular diameter, perimeter, and area on cardiac spiral-CT and high-pitch CTA., Results: The aortic valve was imaged in systole in 90 % of prospective ECG-gated CTA cases but only 50 % of non-ECG-gated CTA cases (p = 0.002). There was a strong correlation (r ≥ 0.94) without significant differences (p ≥ 0.09) between cardiac spiral-CT and prospective ECG-gated high-pitch CTA for all annulus measurements. In contrast, significant differences were found in annular short-axis diameter and area between cardiac spiral-CT and non-ECG-gated high-pitch CTA (p ≤ 0.03). Furthermore, prospective ECG-gated high-pitch CTA showed significantly reduced radiation exposure compared with cardiac spiral-CT (CTDI 4.52 vs. 24.10 mGy; p < 0.001)., Conclusion: PCD-CT-based prospective ECG-gated high-pitch scans with targeted systolic acquisition at the level of the aortic valve can simultaneously visualize TAVR access routes and accurately measure systolic annulus size. This approach could aid in optimizing protocols to achieve lower radiation doses in the growing population of younger, low-risk TAVR patients., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: T. Emrich receives speaker fee, institutional research-/ travel support from Siemens Healthineers and is advisory board member from Siemens Healthineers and consultant from Circle Cardiovascular Imaging. Y. Yang, M. C. Halfmann, D. Graafen and T. Jorg receive institutional research support from Siemens Healthineers. A. Varga-Szemes receives institutional research support and/or personal fee from Bayer, Elucid and Siemens Healthineers., (Copyright © 2024. Published by Elsevier B.V.)

BackgroundSurveys that describe the utilization of cardiac CT are available for the United States, Germany, and Taiwan, but not mainland China.ObjectivesTo analyze the clinical utilization of cardiac CT in mainland China.MethodsA 25-item questionnaire was created and 240 tertiary hospitals were randomly selected to participate. Survey data were collected and confirmed by email as well as phone interviews.ResultsIn total, 237 (99%) hospitals consented to this survey, but 85 were excluded because of lack of cardiac CT patient volume or advanced technology. Finally, 152 (64%) questionnaires were available for analysis. Median patient volume was 1,037 patients (range: 150-8,072) annually. The most common clinical indications for coronary CT angiography were exclusion of coronary artery disease in patients with low to intermediate pretest likelihood, asymptomatic individuals with cardiovascular risk factors, and follow-up after coronary bypass grafting. The median heart rate threshold for beta blocker administration was >70 beats/min; most centers (86%) used sublingual nitroglycerin. Prospectively ECG triggered acquisition was the predominant technique in 44% of hospitals. Most (59%) providers adjusted the tube current to the body mass, but few (16%) adjusted the contrast injection rate. Per case, the mean examination duration was 14.2 min; post-processing time 13.6 min; and reporting time 18.0 min.ConclusionsCardiac CT is widely established in clinical practice in mainland China but there is a need for more uniform standards regarding performance and clinical utilization.

PurposeTo develop and test a time-efficient, free-breathing, whole heart T2 mapping technique at 3.0T.MethodsECG-triggered three-dimensional (3D) images were acquired with different T2 preparations at 3.0T during free breathing. Respiratory motion was corrected with a navigator-guided motion correction framework at near perfect efficiency. Image intensities were fit to a monoexponential function to derive myocardial T2 maps. The proposed 3D, free breathing, motion-corrected (3D-FB-MoCo) approach was studied in ex vivo canine hearts and kidneys, healthy volunteers, and canine subjects with acute myocardial infarction (AMI).ResultsEx vivo T2 values from proposed 3D T2 -prep gradient echo were not different from two-dimensional (2D) spin echo (P = 0.7) and T2 -prep balanced steady-state free precession (bSSFP) (P = 0.7). In healthy volunteers, compared with 3D-FB-MoCo and breath-held 2D T2 -prep bSSFP (2D-BH), non-motion-corrected (3D-FB-Non-MoCo) myocardial T2 was longer, had a larger coefficient of variation (COV), and had a lower image quality (IQ) score (T2 = 40.3 ms, COV = 38%, and IQ = 2.3; all P < 0.05). Conversely, the mean and COV and IQ of 3D-FB-MoCo (T2 = 37.7 ms, COV = 17%, and IQ = 3.5) and 2D-BH (T2 = 38.0 ms, COV = 15%, and IQ = 3.8) were not different (P = 0.99, P = 0.74, and P = 0.14, respectively). In AMI, T2 values and edema volumes from 3D-FB-MoCo and 2D-BH were closely correlated (R(2) = 0.88 and 0.96, respectively).ConclusionThe proposed whole heart T2 mapping approach can be performed within 5 min with similar accuracy to that of the 2D-BH T2 mapping approach.

PurposeTo develop and test the feasibility of a new method for non-ECG-gated first-pass perfusion (FPP) cardiac MR capable of imaging multiple short-axis slices at the same systolic cardiac phase.MethodsA magnetization-driven pulse sequence was developed for non-ECG-gated FPP imaging without saturation-recovery preparation using continuous slice-interleaved radial sampling. The image reconstruction method, dubbed TRACE, used self-gating based on reconstruction of a real-time image-based navigator combined with reference-constrained compressed sensing. Data from ischemic animal studies (n = 5) was used in a simulation framework to evaluate temporal fidelity. Healthy subjects (n = 5) were studied using both the proposed approach and the conventional method to compare the myocardial contrast-to-noise ratio (CNR). Patients (n = 2) underwent adenosine stress studies using the proposed method.ResultsTemporal fidelity of the developed method was shown to be sufficient at high heart-rates. The healthy volunteers studies demonstrated normal perfusion and no dark-rim artifacts. Compared with the conventional scheme, myocardial CNR for the proposed method was slightly higher (8.6 ± 0.6 versus 8.0 ± 0.7). Patient studies showed stress-induced perfusion defects consistent with invasive angiography.ConclusionThe presented methods and results demonstrate feasibility of the proposed approach for high-resolution non-ECG-gated FPP imaging of 3 myocardial slices at the same systolic phase, and indicate its potential for achieving desirable image quality (high CNR and no dark-rim artifacts).

BackgroundData obtained during arrhythmia is retained in real-time cardiovascular magnetic resonance (rt-CMR), but there is limited and inconsistent evidence to show that rt-CMR can accurately assess beat-to-beat variation in left ventricular (LV) function or during an arrhythmia.MethodsMulti-slice, short axis cine and real-time golden-angle radial CMR data was collected in 22 clinical patients (18 in sinus rhythm and 4 patients with arrhythmia). A user-initialized active contour segmentation (ACS) software was validated via comparison to manual segmentation on clinically accepted software. For each image in the 2D acquisitions, slice volume was calculated and global LV volumes were estimated via summation across the LV using multiple slices. Real-time imaging data was reconstructed using different image exposure times and frame rates to evaluate the effect of temporal resolution on measured function in each slice via ACS. Finally, global volumetric function of ectopic and non-ectopic beats was measured using ACS in patients with arrhythmias.ResultsACS provides global LV volume measurements that are not significantly different from manual quantification of retrospectively gated cine images in sinus rhythm patients. With an exposure time of 95.2 ms and a frame rate of > 89 frames per second, golden-angle real-time imaging accurately captures hemodynamic function over a range of patient heart rates. In four patients with frequent ectopic contractions, initial quantification of the impact of ectopic beats on hemodynamic function was demonstrated.ConclusionUser-initialized active contours and golden-angle real-time radial CMR can be used to determine time-varying LV function in patients. These methods will be very useful for the assessment of LV function in patients with frequent arrhythmias.

Cerebrospinal fluid (CSF) dynamics have been mostly studied with cardiac-gated phase contrast MRI combining signal from many cardiac cycles to create cine-phase sampling of one time-averaged cardiac cycle. The relative effects of cardiac and respiratory changes on CSF movement are not well understood. There is possible respiration-driven movement of CSF in ventricles, cisterns, and subarachnoid spaces which has not been characterized with velocity measurements. To date, commonly used cine-phase contrast techniques of velocity imaging inherently cannot detect respiratory velocity changes since cardiac-gated data acquired over several minutes randomizes respiratory phase contributions. We have developed an extremely fast, real-time, and quantitative MRI technique to image CSF velocity in simultaneous multi-slice (SMS) echo planar imaging (EPI) acquisitions of 3 or 6 slice levels simultaneously over 30s and observe 3D spatial distributions of CSF velocity. Measurements were made in 10 subjects utilizing a respiratory belt to record respiratory phases and visual cues to instruct subjects on breathing rates. A protocol is able to measure velocity within regions of brain and basal cisterns covered with 24 axial slices in 4 minutes, repeated for 3 velocity directions. These measurements were performed throughout the whole brain, rather than in selected line regions so that a global view of CSF dynamics could be visualized. Observations of cardiac and breathing-driven CSF dynamics show bidirectional respiratory motion occurs primarily along the central axis through the basal cisterns and intraventricular passageways and to a lesser extent in the peripheral Sylvian fissure with little CSF motion present in subarachnoid spaces. During inspiration phase, there is upward (inferior to superior) CSF movement into the cranial cavity and lateral ventricles and a reversal of direction in expiration phase.

With improvements in surgical and medical management, patients with congenital heart disease (CHD) are often living well into adulthood. MRI provides critical data for diagnosis and monitoring of these patients, yielding information on cardiac anatomy, blood flow, and cardiac function. Though historically these exams have been complex and lengthy, four-dimensional (4D) flow is emerging as a single fast technique for comprehensive assessment of CHD. The 4D flow consists of a volumetric time-resolved acquisition that is gated to the cardiac cycle, providing a time-varying vector field of blood flow as well as registered anatomic images. In this article, we provide an overview of MRI evaluation of congenital heart disease by means of example of three relatively common representative conditions: tetralogy of Fallot, aortic coarctation, and anomalous pulmonary venous drainage. Then 4D flow data acquisition, data correction, and postprocessing techniques are reviewed. We conclude with several examples that highlight the comprehensive nature of the evaluation of congenital heart disease with 4D flow.

BackgroundFerumoxytol is an ultrasmall superparamagnetic iron oxide (USPIO) nanoparticle agent used to treat iron deficiency anemia in adults with chronic kidney disease.ObjectiveWe aim to determine the feasibility of using ferumoxytol for clinical pediatric cardiac and vascular imaging.Material and methodsWe retrospectively identified 23 consecutive children who underwent MRI with ferumoxytol (11 males; mean age: 7.4 years, range: 3 days-18 years), yielding 12 abdominal MR angiography and 15 cardiac MRI studies. Medical records were reviewed for the clinical indication, ferumoxytol dose, injection rate, sedation and any complication. A two-reader consensus scored the images on a five-point scale for overall image quality and delineation of various anatomical structures. Signal-to-background ratios for abdominal aorta and inferior vena cava for abdominal cases and blood pool-myocardium contrast ratios for cardiac cases were calculated. The confidence intervals for obtaining a score of three or above for each image parameter were calculated by using adjusted Wald method.ResultsFor abdominal MR angiography, average scores for overall image quality, as well as delineation of the hepatic artery, superior mesenteric artery, renal artery and veins were 4.5, 4.3, 4.3, 3.7 and 4.7, respectively. For cardiac exams, the average scores for overall image quality, systemic arteries, pulmonary arteries, pulmonary veins, valves and ventricles were 4.4, 4.6, 4.1, 4.8, 4.1 and 4.7, respectively. For all parameters, the lower bound for the proportion of cases to have a score of 3 or above was 65%. Signal-to-background ratios for aorta and abdominal veins averaged 86 +/- 74 and 86 +/- 77 for full-dose images, and 23 and 18 for half-dose images, respectively. Mean blood pool to myocardium contrast ratio was 3:3.ConclusionFerumoxytol can provide excellent image quality for pediatric body MR angiography/MR venography at a dose of 1.5 or 3 mg Fe/kg. Further investigation should be directed toward understanding the lowest dose that can be administered.

Immunoglobulin G4-related disease (IgG4-RD) is a systemic immune-mediated fibro-inflammatory disorder. Coronary IgG4-RD has been scarcely reported and may present as “tumor-like” lesions. These pseudo-masses may be underdiagnosed mainly due to a vague clinical picture that can vary from complete lack of symptoms to acute coronary syndrome or sudden cardiac death. Early recognition of coronary IgG4-RD is essential to monitor disease activity and prevent life-threatening complications. We report a comprehensive non-invasive imaging evaluation of a patient affected by coronary IgG4-RD, which was diagnosed as an incidental finding during routine pre-laparoscopic cholecystectomy checkup. Non-invasive imaging revealed the presence of a peri-coronary soft-tissue mass that was stable at 12 months follow-up.

PurposeTo achieve whole-heart coronary magnetic resonance angiography (MRA) with (1.0 mm)(3) spatial resolution and 5 min of free-breathing scan time.MethodsWe used an electrocardiograph-gated, T2-prepared and fat-saturated balanced steady state free precession sequence with 3DPR trajectory for free-breathing data acquisition with 100% gating efficiency. For image reconstruction, we used a self-calibrating iterative SENSE scheme with integrated retrospective motion correction. We performed healthy volunteer study to compare the proposed method with motion-corrected gridding at different retrospective undersampling levels on apparent signal-to-noise ratio (aSNR) and subjective coronary artery (CA) visualization scores.ResultsCompared with gridding, the proposed method significantly improved both image quality metrics for undersampled datasets with 6000, 8000, and 10,000 projections. With as few as 10,000 projections, the proposed method yielded good CA visualization scores (3.02 of 4) and aSNR values comparable to those with 20,000 projections.ConclusionUsing the proposed method, good image quality was observed for free breathing whole-heart coronary MRA at (1.0 mm)(3) resolution with an achievable scan time of 5 min.

PurposeEstablishing a high-resolution non-ECG-gated first-pass perfusion (FPP) cardiac MRI technique may improve accessibility and diagnostic capability of FPP imaging. We propose a non-ECG-gated FPP imaging technique using continuous magnetization-driven golden-angle radial acquisition. The main purpose of this preliminary study is to evaluate whether, in the simple case of single-slice two-dimensional imaging, adequate myocardial contrast can be obtained for accurate visualization of hypoperfused territories in the setting of myocardial ischemia.MethodsA T1-weighted pulse sequence with continuous golden-angle radial sampling was developed for non-ECG-gated FPP imaging. A sliding-window scheme with no temporal acceleration was used to reconstruct 8 frames/s. Canines were imaged at 3T with and without coronary stenosis using the proposed scheme and a conventional magnetization-prepared ECG-gated FPP method.ResultsOur studies showed that the proposed non-ECG-gated method is capable of generating high-resolution (1.7 × 1.7 × 6 mm(3) ) artifact-free FPP images of a single slice at high heart rates (92 ± 21 beats/min), while matching the performance of conventional FPP imaging in terms of hypoperfused-to-normal myocardial contrast-to-noise ratio (proposed: 5.18 ± 0.70, conventional: 4.88 ± 0.43). Furthermore, the detected perfusion defect areas were consistent with the conventional FPP images.ConclusionNon-ECG-gated FPP imaging using optimized continuous golden-angle radial acquisition achieves desirable image quality (i.e., adequate myocardial contrast, high spatial resolution, and minimal artifacts) in the setting of ischemia.

PurposeTo develop a cardiac and respiratory self-gated four-dimensional (4D) coronary MRA technique for simultaneous cardiac anatomy and function visualization.MethodsA contrast-enhanced, ungated spoiled gradient echo sequence with self-gating (SG) and 3DPR trajectory was used for image acquisition. Data were retrospectively binned into different cardiac and respiratory phases based on information extracted from SG projections using principal component analysis. Each cardiac phase was reconstructed using a respiratory motion-corrected self-calibrating SENSE framework, and those belong to the quiescent period were retrospectively combined for coronary visualization. Healthy volunteer studies were conducted to evaluate the efficacy of the SG method, the accuracy of the left ventricle (LV) function parameters and the quality of coronary artery visualization.ResultsSG performed reliably for all subjects including one with poor electrocardiogram (ECG). The LV function parameters showed excellent agreement with those from a conventional cine protocol. For coronary imaging, the proposed method yielded comparable apparent signal to noise ratio and coronary sharpness and lower apparent contrast to noise ratio on three subjects compared with an ECG and navigator-gated Cartesian protocol and an ECG-gated, respiratory motion-corrected 3DPR protocol.ConclusionA fully self-gated 4D whole-heart imaging technique was developed, potentially allowing cardiac anatomy and function assessment from a single measurement.

PurposeTo determine the clinical outcomes of women and men with nonobstructive coronary artery disease ( CAD coronary artery disease ) with coronary computed tomographic (CT) angiography data in patients who were similar in terms of CAD coronary artery disease risk factors, angina typicality, and CAD coronary artery disease extent and distribution.Materials and methodsInstitutional review board approval was obtained for all participating sites, with either informed consent or waiver of informed consent. In a prospective international multicenter cohort study of 27 125 patients undergoing coronary CT angiography at 12 centers, 18 158 patients with no CAD coronary artery disease or nonobstructive (

PurposeTo develop a framework for prospective free-induction decay (FID)-based navigator gating for suppression of motion artifacts in carotid magnetic resonance imaging (MRI) and to assess its capability in vivo.Materials and methodsAn FID-navigator, comprising a spatially selective low flip-angle sinc-pulse followed by an analog-to-digital converter (ADC) readout, was added to a conventional turbo spin-echo (TSE) sequence. Real-time navigator processing delivered accept/reject-and-reacquire decisions to the sequence. In this Institutional Review Board (IRB)-approved study, seven volunteers were scanned with a 2D T2-weighted TSE sequence. A reference scan with volunteers instructed to minimize motion as well as nongated and gated scans with volunteers instructed to perform different motion tasks were performed in each subject. Multiple image quality measures were employed to quantify the effect of gating.ResultsThere was no significant difference in lumen-to-wall sharpness (2.3 ± 0.3 vs. 2.3 ± 0.4), contrast-to-noise ratio (CNR) (9.0 ± 2.0 vs. 8.5 ± 2.0), or image quality score (3.1 ± 0.9 vs. 2.6 ± 1.2) between the reference and gated images. For images acquired during motion, all image quality measures were higher (P < 0.05) in the gated compared to nongated images (sharpness: 2.3 ± 0.4 vs. 1.8 ± 0.5, CNR: 8.5 ± 2.0 vs. 7.2 ± 2.0, score: 2.6 ± 1.2 vs. 1.8 ± 1.0).ConclusionArtifacts caused by the employed motion tasks deteriorated image quality in the nongated scans. These artifacts were alleviated with the proposed FID-navigator.

Atrial volumetric measurement has proven clinical implications. Advances in cardiac imaging, notably the precision enabled by multidetector computed tomography (MDCT), herald the need for new criteria of what constitutes normal volumetric measurements. With use of 64-slice MDCT, we compared the atrial volumes in healthy individuals with those in individuals with coronary artery disease. By means of manual segmentation, we measured biatrial volume in 686 participants who underwent retrospective electrocardiographic-gated MDCT angiographic evaluation. The study population included a control group of 203 persons with no cardiac abnormalities, and a study group of 483 patients with obstructive coronary artery disease. All variables were compared between men and women and between the groups. We found a significant difference in left atrial end-systolic and end-diastolic volumes between men and women in the control group (P

PurposeTo evaluate Off Resonance Insensitive Complementary SPAtial Modulation of Magnetization (ORI-CSPAMM) and Fourier Analysis of STimulated echoes (FAST) for the quantification of left ventricular (LV) systolic and diastolic function and compare it with the previously validated FAST+SPAMM technique.Materials and methodsLV short-axis tagged images were acquired with ORI-CSPAMM and SPAMM in healthy volunteers (n = 13). The FAST method was used to automatically estimate LV systolic and diastolic twist parameters from rotation of the stimulated echo and stimulated anti-echo about the middle of k-space subsequent to ∼3 min of user interaction.ResultsThere was no significant difference between measures obtained for FAST+ORI-CSPAMM and FAST+SPAMM for mean peak twist (12.9 ± 3.4° versus 11.9 ± 4.0°; P = 0.4), torsion (3.3 ± 0.9°/cm versus 2.9 ± 1.0°/cm, P = 0.3), circumferential-longitudinal shear angle (9.1 ± 3.0° versus 8.2 ± 3.4°, P = 0.3), twisting rate (79.6 ± 20.2°/s versus 68.2 ± 23.4°/s, P = 0.1), untwisting rate (-117.5 ± 31.4°/s versus -106.6 ± 32.4°/s, P = 0.3), normalized untwisting rate (-9.3 ± 2.0/s versus -9.9 ± 4.4/s, P = 0.7), and time of peak twist (281 ± 18 ms versus 293 ± 25 ms, P = 0.04). FAST+ORI-CSPAMM also provided measures of duration of untwisting (148 ± 21 ms) and the ratio of rapid untwisting to peak twist (0.9 ± 0.3). Bland-Altman analysis of FAST+ORI-CSPAMM and FAST+SPAMM twist data demonstrates excellent agreement with a bias of -0.1° and 95% confidence intervals of (-1.0°, 3.2°).ConclusionFAST+ORI-CSPAMM is a semi-automated method that provides a quick and quantitative assessment of LV systolic and diastolic twist and torsion. ORI-CSPAMM corrects off-resonance accrued during tagging preparation and readout and visibly removes chemical shift from the tagging pattern, which confers greater robustness to the derived quantitative measures.

Objective: Cardiac motion and aortic pulsatility can affect the image quality of 3D contrast-enhanced MR angiography (CE-MRA). The addition of ECG gating improves image quality; however, no studies have directly linked image quality improvements to clinically used measures. In this study, we directly compared diameter measurements in the same patient from ECG-gated to non-gated CE-MRA to evaluate the impact of ECG gating upon measurement reproducibility. Methods: Fifty-three patients, referred for thoracic aortic angiography, were enrolled and underwent both non-gated and ECG-gated CE-MRA. Two readers independently measured vessel diameter, image quality, and vessel sharpness at the sinus of Valsalva (SOV), sinotubular junction (STJX), ascending aorta (AAO), distal aortic arch (DLSA), and descending aorta (DAO). Measurement reliability and reproducibility were compared between methods. Results: Image quality with ECG gating was rated significantly higher at the SOV (3.2 ± 0.9 vs 1.2 ± 1.0, p < 0.0001), STJX (3.4 ± 0.7 vs 1.8 ± 1.0, p < 0.0001), AAO (3.5 ± 0.6 vs 1.7 ± 1.1 p < 0.0001), DLSA (4.0 ± 0.1 vs 3.6 ± 0.7, p = 0.006), and DAO (4.0 ± 0.1 vs 3.4 ± 0.9 p < 0.0001) than for non-gated studies. Bland-Altman analyses demonstrated that inter- and intra-observer variability was significantly smaller for ECG-gated MRA at the SOV and AAO. For the non-gated images at the SOV, the 95% limits of agreement for both inter- and intra-observer variability exceeded the growth-rate cutoff for surgical repair (0.5 cm). At the DAO, variability was similar between the two techniques. Conclusion: ECG-gated CE-MRA resulted in improved reproducibility in aortic root and ascending aortic measurements. These data suggest that ECG-gated CE-MRA should be used for the serial assessment of the ascending thoracic aorta. Key Points: • ECG-gated CE-MRA improves the reproducibility and repeatability of measurements of the ascending aorta. • With non-gated CE-MRA, pulsatile motion in the proximal aorta results in significant variability in measurement reproducibility. [ABSTRACT FROM AUTHOR]

BackgroundThe precise localization of the site of origin of a premature ventricular contractions (PVC) prior to ablation would facilitate the planning and execution of the electrophysiological procedure. Current electrocardiographic imaging (ECGI) techniques require body surface maps, a costly and complex procedure, that requires as many as 256 leads to localize the PVC origin. We developed and tested a novel myocardial activation based ECGI technique utilizing the readily available 12-lead ECG to localize the PVC origin.MethodsThe major components of the 12-lead ECGI method are: the source model, proximity effect and spatial orientation, volume conductor, and patient specific model of the heart, lungs, and thorax as derived from magnetic resonance imaging (MRI). For the PVC origin localization, the fastest route algorithm is used on patient specific models created by newly developed morphing software. PVC localization by the 12-lead ECGI was correlated to the site of successful ablation.ResultsSeven patients that underwent electrophysiological mapping and ablation of PVCs were studied. All patients (7/7) had accurate prediction of the PVC origin. However in two patients, no specific MRI was used for localization that resulted in an incorrect switch between the RV free wall and septum of the RVOT. With patient-specific models, these latter two cases would likely be localized correctly.ConclusionsThis feasibility study of a novel myocardial activation-based ECGI using only the standard 12-lead ECG shows promise to localize the origin of PVC. This ECGI method yields activation estimates of isochrones on both ventricles from which the PVC origin location is derived. This method has the capability to localize the PVC from any part of the ventricular endocardium, intra-myocardium or epicardium.